Provider Demographics
NPI:1639202872
Name:KIM W. SLOAN M.D.P.A.
Entity Type:Organization
Organization Name:KIM W. SLOAN M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTION MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-737-5520
Mailing Address - Street 1:1000 MORRIS AVE
Mailing Address - Street 2:D'ANGOLA GYM #103
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7133
Mailing Address - Country:US
Mailing Address - Phone:908-737-5520
Mailing Address - Fax:908-737-5525
Practice Address - Street 1:1000 MORRIS AVE
Practice Address - Street 2:D'ANGOLA GYM #103
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7133
Practice Address - Country:US
Practice Address - Phone:908-737-5520
Practice Address - Fax:908-737-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32112207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52436Medicare UPIN